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FOR OFFICE USE: <br /> -,APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ..7 3.`. . <br /> t This Permit Expires 1 Year From Date Issued Date Issued ..4��%..7 .. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ... d�.............................................., TRACT .......................... <br /> Owner's Name/G .M.i-..../�,.. .�?�t ..................................... ............. . ...................Phone .................................... <br /> Address -- --- .7.-f. 99.1 ---... G.Jf. e -� �=..................... City -�4,ty,�G�'�'L�................................................ <br /> Contractor's Name ...., ... 1,�� C'r -.........................................License #G ''-.-4.82, Phone <br /> Installation will serve: Residence J (Apartment House Commercial Trailer Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:...../.... Number of bedrooms.......Garbage Grinder ....--...... Lot Size .�✓r�` ... �G ....... <br /> Water Supply: Public System and name .... �✓.4�-Tcs 4.4T fir......•................................_.......Private ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom,M <br /> Hardpan❑ Adobe Q Fill Material ............ If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .................... Material.---.................. No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ j No. of Lines ........................ Length of each line............................. Total length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property line ........................ <br /> SEEPAGE PIT [ j Depth ..... ............... Diameter ................ plumber ............................ Rock Filled Yes ❑ No �] <br /> Water Table Depth ................................Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> SepticTank (Specify Requirements) ......... ......... ....................................................................................................................... <br /> Disposal Field (Specify Requirements) .............. ,rrlll'�J..-.------•--•--------.-•--••-----•------------..------- <br /> ..............) ..........--J,-....... .. ----- r-----. `�--?y--/a-r1--.........Rel27 .--- -------- f <br /> Z7 <br /> (Drow xisting and required addition on reverse-side) � 57,t='�� �; ;J <br /> V- <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance wi h San Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not_employ any person In such manner <br /> as to become subjeCctt Workman's Comp nsation laws of California." <br /> Signed <br /> i.--O�^..--....... ...... --.....---•---•................................. Owner <br /> BY -----...:.............................................•-•---•-------•-----....................----•-•.. Title ......... ............................................................. <br /> (If other than owner) <br /> A11FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . _ . .... DATE . .....-..�.._, ................. <br /> BUILDING PERMIT ISSUED ... ... .DATE . ......................................... <br /> ADDITIONALCOMMENTS .. . .. . ... .. ..........................................._..........-••-----..........--•-•-•----......-•--- ............:........................... <br /> ............................................. . . .......................................................................... ..........••••-•••..............••---................ <br /> ............................................ ... ... .... . . ....•-•-••-•........................-••••-••---•..............................•-••-•-••---•--••-•••..........-•-••-•.......... ... <br /> ............................ ............ ....... . ............................................ ......................... .............. .... .... <br /> Final Inspection by . ..................................................................... .Date <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 241.'68 Rev. M 7/72 3 M <br />